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Inspection Summary


Overall summary & rating

Good

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Khalid and Partners on 05 November 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Implement a checking or audit system that enables them to identify patients at risk each time a medicine alert is received and to identify and manage prescriptions that have remained uncollected after an extended period.
  • Collate complaints in the form of a log that enables such trends to be identified and the complaints and their outcomes to be monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 March 2015

The practice is safe and is rated as good.

The practice was consistent over time in its approach to dealing with safety incidents. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed except that medicine safety alerts were not always responded to effectively. Risks to patients were assessed and properly managed. There were enough staff to keep people safe. The practice had plans in place to respond to events that might interrupt their service.

Effective

Good

Updated 5 March 2015

The practice is effective and is rated as good.

Data showed patient outcomes were at or above average for the locality. The practice monitored its effectiveness through the use of clinical audits. Staff referred to guidance from NICE and used it routinely. People’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and planned. The practice could identify all appraisals and the personal development plans for all staff. Staff worked with multidisciplinary teams for patients receiving end-of-life care. The practice ran a range of clinics to promote health and prevent ill-health. The practice was proactive at identifying patients who cared for others.

Caring

Good

Updated 5 March 2015

The practice is caring and is rated as good.

Data showed that patients rated the practice higher than or similar to others for the provision of a caring service. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 5 March 2015

The practice is responsive to people's needs and is rated as good.

The practice understood the needs of its local population and engaged with the Clinical Commissioning Group (CCG) and local NHS trusts to help plan local healthcare services. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed that the practice responded to issues raised.

Well-led

Good

Updated 5 March 2015

The practice is well-led and is rated as good.

The practice had a clear vision and strategy in the form of its published statement of purpose. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular multi-disciplinary governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from patients through the patient participation group (PPG), which it acted on. The practice leadership structure and its status as a training practice lent itself to a learning culture.

Checks on specific services

People with long term conditions

Good

Updated 5 March 2015

The practice is rated as good for the care of people with long-term conditions.

The practice proactively managed the recall and treatment of people with long term conditions and ran specific clinics and medication reviews. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. One of the GPs at the practice had a special interest in cardiology.

Families, children and young people

Good

Updated 5 March 2015

The practice is rated as good for the care of families, children and young people.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who might be subject of a child protection plan. The practice had a designated lead for safeguarding and staff were supported with clear procedures and training. Immunisation rates were similar to the national average for all standard childhood immunisations. Children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors and school nurses, such as ante-natal clinics. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly.

Older people

Good

Updated 5 March 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice had a GP with a special interest of ‘frail and elderly’. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services; for example, in dementia screening, flu clinics and end-of-life care. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice also served the needs of four local care homes.

Working age people (including those recently retired and students)

Good

Updated 5 March 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care; for example, extended early morning and late evening appointments twice weekly. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group such as the NHS adult health checks and lifestyle clinics.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 March 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

97% of people identified as experiencing poor mental health had received an annual physical health check which was significantly higher than expected. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE and had a primary care liaison worker to facilitate a single point of entry to mental health services. The practice also had individually tailored care plans for people with poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 5 March 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks for people with a learning disability and data showed that all of these patients had received a follow-up. It offered longer appointments, and appointments out of scheduled times for people with a learning disability or for those with complex needs. People who were non-residents could access the service as registered temporary residents.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations, such as those for substance misuse those for patients who were caring for others. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.